Tuesday, 30 June 2015

Victoria's prison system is "very ready" for a smoking
ban which comes into effect on Wednesday, Corrections Commissioner Jan
Shuard says.

The Victorian Government flagged a ban would be put
in place about a year ago and since then the Corrections Department has
been working with Quit Victoria to tailor programs specifically for the
inmate population.

About 84 per cent of people going into the
state's 14 prisons smoke, and about 1,300 prisoners or 20 per cent of
the prison population, have attended quit programs up until the end of
May.

"This has been 18 months in the making. We've had a very
long-term project in place to work with both our staff and the prisoners
in preparing for [the ban]," Ms Shuard told 774 ABC Melbourne.

A huge riot has broken out at a prison in Australia over a smoking ban.

Inmates at Ravenhall prison span out of control today and prison staff were evacuated at the maximum security facility.

Television footage from the prison in Ravenhall, a suburb of Melbourne, showed prisoners with their faces covered, carrying sticks as makeshift weapons, while smoke was also seen. As many as 300 inmates were involved, the Australian Broadcasting Corporation said.

And it's not even Wednesday yet.

Send the cleaning up bill to the anti-smoking fanatics who lobbied for this (indoor and outdoor) ban.

Monday, 29 June 2015

The Observeris probably the most gullible newspaper when it comes to 'public health' quackery so it's no surprise to see it reporting this...

Imposing a minimum unit price for alcohol leads to a dramatic fall in
drink-related crime, including murders, sexual assaults and
drink-driving, a new study shows.

Crimes perpetrated against people, including violent assaults, fell
by 9.17% when the price of alcohol was increased by 10% over nine years
in the Canadian province of British Columbia.

This is based on a feeble correlation and correlation almost certainly doesn't imply causation in this instance. Tim Stockwell—for it is he—doesn't bother to find a control group to so I have done it for him at The Spectator. It turns out that minimum pricing in British Columbia correlates better with crime in Britain than it does in British Columbia. Now that's magic.

The Centre for Alcohol Policy Research in Melbourne, which explored
research areas such as the cost and harms of "passive drinking", has
lost its $170,000 annual government funding, about 10 per cent of its
funding base.

I'm amazed it's only 10 per cent, to be honest.

Spokesman Michael Thorn said the funding cut meant
the centre would no longer be able to pay its international expert
Professor Robin Room.

Mr Thorn said that without Professor Room, the centre would be forced to close.

Eh, what? You've still got 90 per cent of your funding left - or so you claim.

"An
academic research centre of this standing requires a world-class
researcher. Without a world-class researcher there is no centre," he
said.

Far be it from me to suggest a way to keep this ghastly organisation going, but surely sacking somebody else is the obvious alternative?

There has been much wailing and gnashing of teeth in the public health racket about the departure of Robin Room (whom we have encountered before on this blog). He is regarded as something of an pioneer and if you read his scintillating memoir A Book of Letters for Robin Room, you can see why...

‘Alcohol Control Policies in a Public Health Perspective' broke so many areas of new ground. We called it the Purple Book and I worked on it in 1974–75. The authors came from five countries and were a motley bunch of sociologists dressing ourselves up as public health experts.

A new study of the neo-temperance lobby's tricks of the trade was published this week. It is paywalled but can be read here. In it Alfred Uhl from the Austrian Public Health Institute looks at several examples of wishful thinking, faulty logic and statistical foul play by people who want to more and more taxes and restrictions on alcohol.

Put simply, the activist/academics who dominate the discussion of alcohol policy in the most prominent 'public health' groups have decided that tobacco-style bans and taxes are the way to deal with alcohol-related health problems and no amount of evidence is going to deter them.

Take Peter Anderson, for instance, a temperance academic who wears many hats, including that of project leader at the EU-funded ALICE-RAP project...

The fact that Anderson et al. (2012) present tax increases and bans on alcohol advertising as two of the most effective measures does not only contradict the conclusions that Anderson and Baumberg (2006) had drawn a few years earlier: ‘Looking across Europe more thoroughly there is no apparent correlation between the revenue from alcohol-specific taxes and per capita consumption’, but also those of Babor et al. (2003), who had rated advertising bans as rather ineffective. It is interesting to observe here, regarding the relationship between alcohol taxes and per capita consumption, that real alcohol prices in Austria dropped by around 50% over the past four decades, while per capita alcohol consumption did not increase; rather, it fell by 20%.

On the selective omission of facts:

An illustration of how it is possible to present statistical findings in a way that best supports the policy conclusion desired is that of Edwards et al. (1994) using data from an article by Hurst (1973), who had reanalysed data stemming from the influential Grand Rapids Study. In a well-planned roadside study, Borkenstein, Crowther, Shumate, Ziel, and Zylman (1964) had shown that drivers with moderate alcohol levels around 0.3 g/l blood alcohol concentration (BAC) had a significantly lower risk of committing an accident than completely sober drivers, an effect referred to as the ‘Grand Rapids dip’. When Hurst reanalysed these data separately for groups with similar drinking habits, he could show that the Grand Rapids dip was an artefact due to a Simpson paradox (where heterogeneous samples are analysed, the overall effects can be the opposite of the effects in all homogenous subsamples), leading to erroneous interpretations. In effect, the risk of committing an accident rises almost linearly with the amount of alcohol consumed, which is a positive result for those who support Zero-BAC-limits for drivers. However, Hurst also found that the risk of committing an accident in a completely sober state is four-fold for abstainers compared to daily drinkers, with daily drinkers reaching the risk level of abstainers after they exceed a BAC level of 1.0 g/l, which is twice the legal limit for drivers in most European countries. This finding about the ‘dangerous abstainers’ is hard to explain and is certainly an unwanted result for alcohol control activists. Edwards et al. (1994) chose to document the pleasant effect and hide the unwelcome effect by standardising the risk at Zero BAC level to 1 for every group. They could thus demonstrate the linear increase of risk with increasing BAC-levels, but hide the differences at Zero BAC levels: a brilliant trick for an advocate, but hardly excusable for a scientist.

On the deliberately misleading cost-of-alcohol studies...

A popular argument raised to support a strict alcohol control policy is the high social cost of alcohol use for society. Anderson and Baumberg (2006) stated the loss to be 1.3% of GDP. It can easily be shown that the logic of such cost calculations is systematically flawed, since the costs are, to a large extent, not paid for by the non-involved others or from the public purse. Alcohol-induced premature death undoubtedly causes high intangible costs for the persons drinking excessively (internal costs) and their near environment, but dead persons – similarly to children not born due to contraception or young immigrants not allowed to enter the country due to strict immigration laws – neither produce nor consume any goods... These figures are a perfect advocacy tool for alcohol control activists, and they help preventionists, therapists and researchers justify funding for their activities.

On presenting correlation as causation...

An illustrative example by Anderson and Baumberg (2006, p. 147) is the way in which the relationship between heavy drinking and suicide is presented in the following terms: ‘Heavy drinking is a major risk factor for suicide and suicidal behaviour among both young people and adults’. Knowing that heavy alcohol consumption is commonly a consequence of psychiatric problems such as depression, an adequate causal interpretation would be that persons with a tendency to heavy alcohol use have an increased suicide risk, and that it is likely that drinking excessively increases the suicide risk even further. There is also little doubt that some suicides are a consequence of depression caused by drinking alcohol in individuals who otherwise would not have killed themselves, but what fraction of suicides is due to the primary disease and what fraction is due to alcohol problems cannot be answered properly if only the association is recorded. A certain percentage of depressed persons who eventually commit suicide and use alcohol to self-medicate their depression may even have lived longer since this form of self-medication made them postpone their suicide. It cannot be denied that excessive alcohol may cause depression and suicide, but to interpret and present associations in the usual way, without considering widely known facts and cultural contextual factors and without presenting different explanations is misleading.

Finally, some wise words about the bluff of 'evidence-based policy' which really just means 'evidence that the policy we propose will do the thing we want it to'...

Examples from key publications supporting evidence-based alcohol policy show that much of it should more realistically be labelled ‘policy-based evidence’... By taking a stand against certain value-driven positions which unjustly
claim a degree of proof that is not factually justified, the present
article argues for greater modesty and not at all for moving back to
well before the age of enlightenment, when relying uncritically on
authority, experience and intuition was the name of the game.

To demand that political decision-makers should implement evidence-based policies is particularly misleading, since it suggests that policy (what should be done) can be derived from empirical research (what is), which is a popular misconception, labelled a ‘naturalistic fallacy’ by Moore (1960). All empirical claims raised in discussions about policy should correspond as closely as possible to reality, but practical decisions are always rooted in ethical–political value decisions related to the image of humanity, society and the world (Uhl, 2007). This aspect is camouflaged by the term ‘evidence-based policy’. The question of how paternalistic an administration should be, or how far the views of the majority of the population in a democratic society should prevail (that is how far it is legitimate to coerce individuals in a society to behave in a healthy way) is an ethical–political decision to be decided very carefully and is not simply factual–scientific.

Thursday, 25 June 2015

On Sunday, The Observerpublished a front page story in which "leading charities and independent experts" confidently predicted that the Office for National Statistics was about to announce a shocking rise in the poverty rate. The figures were released today. There was no rise at all.

Remember Aseem Malhotra's dreadful article which claimed that there was no link between physical inactivity and obesity? It was not peer-reviewed at the time but it has now received a retrospective peer review. As you might expect, it is not pretty.

Tuesday, 23 June 2015

A recent article in the Journal of the American Medical Association discusses the decline in hospitalisations for children with gastroenteritis after the rotovirus vaccine was introduced in 2006. It is a good news story but I can find no record of it being reported anywhere outside the specialist medical press. It comes with a graph which tells the story very clearly...

Note the straightforward presentation of the data, with the decline in admissions being immediately visible after 2006. There is no modelling, remodelling, trickery, counterfactuals or any kind of flim flam.

Contrast this with the widely reported study which claimed that there was a large reduction in hospitalisations for children with respiratory disease after the smoking ban was introduced in England. That study also came with a graph, but it clearly showed a rise in admissions. The rest of the story came from the wishful thinking of activist-researchers and an indefensible methodology. Pitifully, the media lapped this up as proof that "11,000 fewer children have been admitted to hospital with lung infections since the ban was enforced".

Or contrast it with the study (involving the same author, Christopher Millett, plus Stanton Glantz) which claimed that there was a dramatic decline in childhood admissions for asthma after the same smoking ban. This time, the rate was roughly the same before and after ban, but once again the activist-researchers retrospectively painted a slightly higher line above the post-ban series in a (successful) attempt to fool the media into believing there had been a "sharp fall" (as the BBC put it).

What these graphs really show is the difference between science and 'public health'. It is the difference between medicine and political activism. It's a big difference, as big as the difference between hospital admissions falling and hospital admissions rising.

The first graph shows a major decline in hospital admissions as the result of effective, evidence-based medicine. The results speak for themselves. They require no salesmanship, no spin and no statistical tricks.

The other two graphs show no decline in admissions. That is hardly surprising since the intervention was an evidence-free political act drawn up by single-issue pressure groups who have little, if anything, to do with health and nothing at all to do with medicine.

The first study is a serious piece of research which received no media attention. The other two studies are policy-driven quackery of the worst kind which received global media attention.

Monday, 22 June 2015

On Friday, Aseem Malhotra, Mike Lean and some chap from the NHS wrote a factually inaccurate, incoherent and largely off-topic response to an article I wrote in the Spectator which said that obesity predictions were risible and that longevity is the real threat to the NHS.

Two weeks ago I wrote an article for the Spectator
in which I argued that obesity predictions are not worth the paper
they’re written on and that the healthcare costs of obese people tend to
be lower than those of people who are of ‘normal’ weight. Both
arguments can be easily backed up with evidence, but since they
undermine the narrative of an obesity time bomb destroying the NHS, they
are rarely acknowledged and often contradicted.

Aynsley Green, the former children's commissioner for England, wants warnings on labels to state clearly that "alcohol can damage the health of your unborn child." At the moment many bottles and cans carry a symbol showing the silhouette of a pregant woman with a line through it. Campaigners for and against the warnings argue that this has no impact.

Aynsley Green says the graphic images similar to those used on cigarette packets should be considered.

Sunday, 21 June 2015

Jamie Oliver, the celebrity chef and cockwomble, has decided to introduce a soda tax in his restaurants "to send a powerful and strong message to government". He claims that he will give money raised to the state-funded sock-puppet charity Sustain, who are agitating for a soft drinks tax that will cost taxpayers £1 billion a year.

If Oliver feels so strongly about fizzy drinks he could simply stop selling them, but that would hit his bottom line so he'd rather gouge his customers to fund a campaign for a state-sanctioned 'level playing field' that will rip off his competitors' customers too.

To stop selling sugary drinks would require Oliver to show a degree of consistency and integrity that he has rarely displayed. Chefs are on very shaky ground when they start demonising a widely used ingredient like sugar (and, before that, butter) because it is likely that they use it more widely than most. If you're going to claim that sugar is "the next tobacco" you need to make sure that you don't lace your own food with it.

I haven't read Jamie Oliver's cook books, and I never will, but his cake recipe in the Sunday Times three weeks ago caught my eye...

Those 57.5g of sugar per slice amount to 14 teaspoons of sugar.* For the sake of comparison, a can of Coke contains 9 teaspoons and the World Health Organisation recommends that people consume no more than 12 teaspoons per day. Pucka!

If you can bear to take a grisly trip down memory lane, here is Jamie Oliver trying to be a lad in the early noughties, demanding a "greasy fry up" with "none of that low fat malarkey". Aside from being a reminder that Oliver has always been intensely irritating, it is a nice example of how supermarkets responded to the scientific consensus about saturated fat—a scientific consensus that has since turned on a sixpence.

* Ideally, the WHO think we should limit consumption to six teaspoons but they admit that this is based on "weak evidence".

Tuesday, 16 June 2015

An Australian academic called Roger Magnusson has written an article for the journal Public Health about 'nanny state name-calling'. Insofar as he has a point to make, it is that the things libertarians complain about do not actually impede liberty. He uses several 'cases studies' in his article to illustrate this, including a rant by Rush Limbaugh and articles by Jacob Sullum and Christopher Hitchens.

He lets himself down badly by understanding neither what the market is nor what the people he is criticising actually believe. With regards to Limbaugh, he characterises his position (and, therefore, the 'neoliberal' position) as follows:

The state should be agnostic about what citizens choose to eat and
drink, and whether or not they smoke, deferring instead to the wisdom of
the market.

But the market represents nothing more that the aggregated decisions of citizens. It would make more sense to say: "The state should be agnostic about what citizens choose to eat and
drink, and whether or not they smoke, deferring instead to the wisdom of citizens." This, of course, is an eminently respectable and liberal position to take. You would have to be a snob or a control freak to disagree with it, hence the need to obfuscate with talk of 'the market' as if it were something that is imposed on people.

...in an article entitled ‘The war on fat: is the size of your butt the government's business?’,
Joseph [sic] Sullum frames government actions to reduce population weight
gain as anti-capitalist manipulation. ‘[T]he war on fat … reflects an
anti-capitalist perspective that views people as helpless automatons
manipulated into consuming whatever big corporations choose to produce.
The anti-fat crusaders want to manipulate us, too, but for our own
good’.

His name is Jacob Sullum, not Joseph Sullum, but hey, this is a public health paper, we can't expect the peer review to pick up these things...

There are some important lessons here for public health
campaigners. Nanny state theorists have become experts in framing health
interventions as insults to the dignity and intelligence of ordinary
people. This helps to explain why the nanny state critique applies not
only to interventions that truly restrict the freedom of individuals
(e.g. smoke-free laws), but to non-coercive, information-based
interventions – like health warnings, and clearer nutrition labelling –
that are aligned with the values of consumerism: informed choices and
personal responsibility.

That really depends on what you call 'non-coercive'. Sullum's article was about Kelly Brownell, a leading campaigner for the 'Twinkie tax' and other illiberal anti-obesity interventions. As Sullum explains, Brownell intends to reduce obesity "through a combination of taxes, subsidies, censorship, and
regulation." You don't need to be a radical libertarian to view sin taxes as a restriction on liberty—they are, after all, essentially fines for living your life as you see fit. Nor is it ridiculous to see advertising bans as a form of censorship which negatively impacts consumers by limiting the information available to them. Banning adults from hearing or viewing commercial speech can very easily be considered as both a limit on freedom and an insult to the "dignity and intelligence of ordinary people." And that's before we even get to the freedom of people in business, whom Magnusson is not interested in at all.

It is true that nutritional labelling is not a restriction on liberty as such, but that is not what Sullum was writing about. It is also true that plain packaging is less of a threat to smokers' liberty than smoking bans, but this is only a question of degree. Plain packaging has all the hallmarks of the nanny state—it is patronising and excessive, for a start. It infringes property rights and one of its explicit aims is to make smokers enjoy their cigarettes less. Smoking bans are arguably worse. They seriously hinder people's freedom of association as well as infringing property rights. But the fact that one is worse than the other does not make the other okay. Both justify the nanny state tag which is, after all, a pretty mild pejorative.

As for the public health crusade being "anti-capitalist", if you doubt this then spend a little time familiarising yourself with the likes of Gerard Hastings, Martin McKee, Richard Horton, Michael Jacobson, Michael Marmot, Richard Wilkinson et al. (see here, here and here for a taster).

With the exception of smoke-free laws, and notwithstanding the
unsuccessful efforts of New York City's Health Department to impose a
maximum serving size of 16 fluid ounces (473 ml) for sugar-sweetened
drinks,
the popularity of the nanny state metaphor does not demonstrate that
personal liberty and freedom are being seriously threatened by
government.

Woah, there. That sweeping statement requires some examination. The only public health policies that threaten personal liberty are bans on smoking and Big Gulps? I think not. Extortion through taxation and censorship through advertising surely merit inclusion, as do minimum pricing, licensing restrictions, and bans on happy hours, alcopops, drinking in the street, menthol cigarettes, snus, e-cigarettes... The list is pretty much endless. Bans are the stock in trade of public health and bans restrict freedom by definition.

Magnusson then launches into a crass, ill-advised and incoherent 'case study' of the much-missed Christopher Hitchens. He picks Hitchens because he was an eloquent critic of the nanny state who died of a smoking/drinking-related disease. Magnusson writes...

Hitchens' resistance to smoke-free laws in public places is less
consistent with libertarianism, and more consistent with the view that
non-smokers should be obliged to put their health at risk to accommodate
smokers.

Not if you know anything about libertarianism, it isn't. It is highly consistent with libertarianism to say that a bar-owner should be allowed to decide whether or not people smoke on the premises. Non-smokers are free to go elsewhere. The owner has no obligation to 'accommodate' them, nor does a non-smoking owner have an obligation to accommodate smokers. Their gaff, their rules. Since even Magnusson concedes that smoking bans "truly restrict the freedom of individuals" it should be obvious that any principled libertarian would oppose them.

Magnusson clearly thinks that Hitchens got his comeuppance when he died of cancer and wants to believe that he renounced his principles on his death bed.

Yet it is precisely at the time when illness strikes – when it will
usually be grotesquely inappropriate to highlight an individual's
misfortunes for the purposes of public policy debate – that one truly
catches a glimpse of the public interest that public health policies are intended to protect.

Despite it being "grotesquely inappropriate to highlight an individual's
misfortunes for the purposes of public policy debate", this is exactly what Magnusson is doing. The problem is that Hitchens is a poor example of a sinner repenting. He didn't, really. Magnusson claims that "experience changes perspectives – even those of nanny state critics". That may often be true—regrets are easy to have—but despite his appalling illness, Hitchens explicitly said...

‘It sounds irresponsible if I say yes, I'd do all that again … [b]ut the
truth is it would be hypocritical of me to say no, I'd never touch the
stuff if I'd known, because I did know, everyone knows … I decided all
of life is a wager … It's strange, I almost don't even regret it,
though I should.'

Despite quoting these lines, Magnusson nevertheless concludes that Hitchens' "[cancer] diagnosis created a rare opportunity for a seasoned nanny state theorist to re-consider that critique". Even if this weren't incredibly tasteless, Magnusson could hardly have found a less fitting person to use as an example.

Having danced on Hitchens' grave, Magnusson displays some semblance of understanding why people care about lifestyle freedoms...

There are two sides to this libertarian impulse. The first
is personal autonomy, which reveals itself in an instinctive opposition
to any government intervention that affects the freedom of the
individual. The second is personal responsibility, reflected in the
belief that individuals must be self-reliant, rather than dependent upon
government, and in the belief that individuals are, in fact, wholly
autonomous, free from influence, and adapted to the challenges of their
environment. If the first side of the libertarian coin (personal
autonomy) is a shield against the totalitarian state, the second side
(personal responsibility), protects against the nanny state.

That's about right. However...

Conspicuously absent from most nanny state rhetoric is any genuine
attempt to engage in the messy business of defining the appropriate
balance between the interests that society has in an efficient private
sector, a high standard of health across the community, and a free
society that gives individuals genuine space to choose and to grow as
individuals.

Really?! Have the last 300 years of philosophy and political economy not existed?

Although it is possible for governments to trample on the dignity and
civil liberties of individuals in pursuit of better health outcomes,
most nanny state criticisms offer no hint of a workable test for
identifying when public health measures ought to give way to
self-governance.

Oh yeah? Then how about this, from John Stuart Mill?

"The only purpose for which power can be rightfully exercised over any
member of a civilized community, against his will, is to prevent harm to
others."

This one line has been the subject of millions of written words since 1859. There are so many books and essays on the subject of the public good versus individual liberty that it is doubtful that any one person will ever read them all. It has arguably been the central question in political writing since the French Revolution. Every serious critic of the 'nanny state' has addressed it. You don't have to agree with the libertarian position, but you can't just pretend that it amounts to no more than saying the words 'nanny state'.

Mill's harm principle is an easily understood and workable test. It might not be perfect, but it works pretty well as a rebuttal to 'public health' paternalism. By contrast, Magnusson acknowledges that governments can "trample on the dignity and civil liberties of individuals in pursuit of better health outcomes" but provides no test to show when this line is crossed. Is it too cynical to suggest that Magnusson's line is crossed when it involves something he likes doing?

The real
concern of nanny state theorists is not freedom as such, but the role of
the state.

Yes, freedom from the state! It is impossible to discuss the freedom of the individual without discussing the role of the state. Only in the wacky world of 'public health' do the fundamental threats to freedom come from Coca-Cola and Burger King.

Nanny state name-calling reflects the irreconcilable contest between
what Robert Beaglehole and Ruth Bonita have called a ‘social policy
approach to healthy lifestyles’,
and a neoliberal philosophy that seeks to shift social responsibilities
‘from the public sphere (where they formed part of the business of
government) to the private sphere (where they become matters of only individual, familial or household concern).’

Er, that's begging the question, isn't it? How about we ask why "social responsibilities"—like whether adults can buy tobacco, alcohol and food at the market price from whomever they choose—should be shifted from the private sphere, where they have traditionally belonged, to a bunch of control freak politicians, half-witted academics and fanatical single-issue pressure groups?

Neoliberals want to liberate the state from being held accountable for the health of the population.

Again, this is an assertion dressed up as fact. The state is not accountable for the health of the population unless it is actively harming the health of the population.

During the 20th century, law has been an indispensable part of many
advances in public health, contributing to reductions in road traffic
injuries, the control of infectious diseases, safer and healthier foods,
safer workplaces, and fewer deaths from tobacco.

Let's take these one at a time. Road traffic laws are rules of conduct for motorists designed to protect the individual from other drivers—the only exception is seat belt laws which are contentious amongst libertarians. Road accidents are not a public health issue. They are an issue of safety and the car industry has done at least as much as the state in improving safety.

Infectious diseases are a public health issue because they can usually only be dealt with by collective action.

Food standards are also a suitable area for government action because nobody would wish to eat an unsafe food. People do, however, wish to smoke tobacco, drink alcohol and eat 'unhealthy' food. Tackling unsafe food and infectious diseases are uncontroversial precisely because they represent risk without benefit, whereas the current targets of 'public health' involve products about which the individual is capable of making a trade-off between risk and benefit.

In extreme cases, government action on supposedly unsafe food, as with unsafe workplaces, becomes controversial, excessive and illiberal (there are any number of ridiculous Health and Safety rules to illustrate this).

Finally, the credit that can be given to government for reducing the smoking rate, beyond educating people about the dangers, is questionable. There is considerable evidence showing that 'smokefree' laws, graphic warnings and plain packaging, to name but three, have been hopelessly ineffective on this score.

Oh, and as for 'healthier foods', I thought the rationale for 'public health' intervention in diets was that foods have become less healthy?

Self-evidently, these advances would not have happened unless the state
acknowledged its responsibility for the health of the population.

It's not self-evident at all. There are some things that individuals cannot do alone which require collective action. It is no use being a careful driver if someone is going to drive at you at 100mph whilst inebriated. Vaccinations do not work properly unless the vast majority of people take them. It is not a question of the state taking ownership of the people's health. It is that people sometimes use the state to achieve for themselves what they cannot achieve individually.

By contrast, someone who doesn't want to eat at McDonald's can do so without any help from the state. See the difference? That, in a nutshell, is the difference between a public health issue and a 'public health' issue.

One of ASH's most vulnerable flanks is that the tax rises they have demanded for the last forty years are highly regressive, plunging hundreds of thousands into poverty. Almost unbelievably, they have come out with a report that accuses smoking - not tobacco taxes, oh no! - of plunging hundreds of thousands of people into poverty. ASH also pull the old 'tobacco taxes are progressive because the poor
are most likely to quit as a result' line. It is a demonstrable lie, as this study (amongst many others) makes clear.

Rob Lyons at Spiked has written about this astonishing attempt to turn defence into attack so I don't have to....

You’ve got to admire the folks at Action on Smoking and Health (ASH). Not
for their puritanical, tobacco-hating monomania, of course, but for
their sheer chutzpah. This is an organisation that should have brass
balls on its logo. ASH’s latest effort at ignoring the facts is so
brazen that even former Iraqi government spokesman Muhammad Saeed
al-Sahhaf, aka ‘Comical Ali’, would have to doff his beret in respect.

Sunday, 14 June 2015

BBC Radio 4's More or Less examined the recent obesity predictions on Friday and more or less came to the same conclusion as me. Indeed, you can hear me talking about previous obesity babble on the programme. There's also an interesting item about the price of drugs, featuring Jamie Bartlett who has conducted some good research on alcohol and whose book, The Dark Net, I reviewed here.

Friday, 12 June 2015

The French wine industry will be raising a glass to MPs on Thursday after they voted in favour of relaxing France's stringent laws around the advertising of alcohol.

These are the famous Evin laws which ban alcohol advertising in many places and limit what remains to the bare bones of basic information. A gaggle of temperance groups in the UK are itching to copy this model, naturellement.

France’s tight controls over advertising of alcohol were brought in
back in 1991 as part of a bid to cut a worrying rise in alcohol
consumption - especially among young people.

As you would expect from the economic evidence on advertising, the Evin laws had no effect on aggregate consumption or drunkenness. Since France banned alcohol advertising "there's now a real trend among French youths to drink more regularly,
usually at weekends; to drink more; to drink outside, in the streets;
and to drink in order to get smashed".

Read the whole article for the details of why the Evin laws have been relaxed (lobbying from the wine industry, basically). It includes this gem:

Claude Evin, the man behind the 1991 law, who is now head of the
Ile-de-France health association said the change would be a slippery
slope and effectively lead to “any kind of advertising” being allowed.

Wednesday, 10 June 2015

In April, when I reviewed the Conservative party manifesto, I wrote...

They claim to be "helping people to stay healthy by ending the open
display of tobacco in shops, introducing plain–packaged cigarettes and
funding local authority public health budgets." There is no mention of
any other anti-smoking policies, presumably because they're waiting for
ASH to tell them what to do.

It hasn't taken long. Barely a month after a winning an election on the back of a manifesto that didn't say anything about new anti-smoking policies, the Conservatives have been huddling with ASH in the House of Commons to discuss how to persecute smokers for the next five years.

As Guido reports, ASH - the state-funded 'charity' - was launching its new manifesto with Jane Ellison - the public health minister - yesterday afternoon in a House of Commons dining room. How very cosy.

Regular readers will remember it was Ellison that shoehorned
plain-packaging through the House of Commons during the dying embers of
the last Parliament, without so much as a debate in the Commons. She’s a fully paid up nanny-stater, and clearly has no qualms sharing a platform with the health fascists.

I've wrote about the content of ASH's wish list last week for the Spectator. It is full of disgraceful, regressive and socially destructive ideas. Here's a précis...

Increasing tobacco duty by 5 per cent (plus inflation) every year

ASH's plans will mean that a single cigarette will cost a pound by 2025. Almost unbelievably, ASH's press release complains about smokers
being impoverished despite it being their own policies that make the
poor poorer. When tobacco duty makes up 80 per cent of the price of a
pack of cigarettes, it is hardly surprising that smokers tend to be
poorer than non-smokers, nor is it surprising that the UK is awash will
counterfeit and contraband tobacco.

Tobacco levy

This is the policy that Arnott really has her
beady little eyes on. She's hoping the government will loot from the
tobacco industry and give the money to her and her mates in tobakko
kontrol. It won't work, as you can't levy a windfall tax on companies
that are not based in the UK, including JTI and Philip Morris, and those
which are will likely decide to move their headquarters to a country
where they're not going to be plundered by an arbitrary and capricious
government.

Banning actors from smoking on stage

It says a lot about ASH's petty, obsessive and mean-spirited mentality that they are prepared to fight to close this tiny loophole - a loophole that they were happy to include when they drew up the smoking ban ten years ago.

Banning smoking outdoors and in cars

A ban on smoking outdoors is bullying and harassment of the most spiteful kind. There is, of course, not a shred of evidence about secondhand smoke to justify it. Similarly, ASH want a ban in cars regardless of whether a child - or anybody else - is present.

Just as yesterday's push by the Welsh government to ban vaping indoors proved that public health is not about health, so this proves that smoking bans have nothing to do with secondhand smoke.

In recent years, ASH has pretended to be attacking the tobacco industry rather than smokers with policies such as the display ban and plain packaging. If it does nothing else, their new hit list should make it abundantly
clear that they are not just anti-smoking, they are anti-smoker.

And if you had any doubt that the British Meddling Association is a disgraceful, scientifically illiterate organisation, listen to their arrogant representative from 2 hours 25 minutes here. The reaction of the presenter makes me think that the 'trust me, I'm a doctor' schtick that has allowed them to get away with lying for so long is starting to wear thin.

Monday, 8 June 2015

The Telegraph has run a story about sugar not making children hyperactive. It's not the first time this has been pointed out. It has often been reported that the sugar-hyperactivity theory is a myth - see here, here and here for example - but since it is a very pervasive myth it does no harm to mention it again.

The Telegraph report is based on a comment by a psychologist, David Benton, at a recent science festival, so it is not really news, but at least it is true. Benton is also quoted as saying, quite correctly, that the release of dopamine in the brain that comes about as a result of eating sugar does not mean that sugar is like cocaine.

So far, so good. But the article ends with what can only be described as a deranged rant by Graham MacGregor, the chair of Action on Sugar (and also the chair of Consensus Action on Salt and Health), who says...

“The food industry is overfeeding us with vast amounts of sugar,” he said.

“Why should we ban tobacco while allowing advertising of food that is
going to kill people? It’s a scandal. We need a tax on soft drinks.

"What we eat is now the biggest cause of death and disability in the
world and food industry to blame. Processed food is full of fat and salt
and sugar with no feeling of satiation."

Can a grown human being have really spouted these words? Doesn't he sound like a parody of a swivel-eyed fanatic?

I would be genuinely fascinated to know what Telegraph readers think when they read MacGregor's comments. The majority of them, surely, will think 'phew, what a loony', but there must be some that nod along. Some of them will no doubt think that he must know what he's talking about because he's a doctor.

A few readers may even think MacGregor's views are the only sensible thing in the article. They may actually believe that processed food provides "no feeling of satiation" or that tobacco and sugar are basically the same thing. They may believe that the food industry is responsible for "the biggest cause of death and disability in the world"—a nonsense claim based on a ridiculous methodology.

I am inclined to think that the best thing to do with MacGregor is to let him talk (likewise his chump of a colleague Aseem Malhotra), but it is scary to think that somebody out there must fall for this rubbish.

Sunday, 7 June 2015

I've got an article in this week's Spectator alongside an excellent piece by Douglas Murray. Both articles discuss the way in which the NHS is used to scapegoat certain groups and justify social engineering. We talk about this issue in greater length in the Spectator podcast ('The high priests of health') which I also recommend.

Thursday, 4 June 2015

I didn't intend to revisit the Australian tobacco sales data again. The only remarkable thing about them is that, after years of decline, they didn't fall in the first year of plain packaging. In fact, the latest set of figures (which are continually revised) show that they rose every quarter.

I have shown this severaltimes in graphs but, for the avoidance of doubt, here are the seasonally adjusted chain volume figures in numbers for the year before plain packaging began and the year after. You can check them here if you wish. Look for column AM.

March 2013: $3,688m
June 2013: $3,721m
September 2013: $3,756m
December 2013: $3,761m

Considering that the black market in tobacco also grew significantly in 2013, plain packaging looks like the dog's dinner of a policy that it is.

However, in the second year of plain packaging, there was a stonking tax rise on cigarettes and the decline resumed (probably aided by the growth of e-cigarettes). This has saved the anti-smokers' blushes in the eyes of anyone too thick to see what's going on. They can now truthfully say that fewer cigarettes are being bought (legally, anyway) than before the policy was introduced.

This is what the graph looks like with the most recent quarters included...

It should be obvious to anyone with eyes that plain packaging had bugger all effect - indeed, may have had a negative effect - and that it took a big price hike (and the rise in e-cigarette use) to make sales fall at a similar rate to that seen before plain packs were introduced.

That's not good enough for the retired sociologist Simon Chapman, currently residing at Sydney Nursing Home for the Terminally Deluded, who has hilariously declared victory by tweeting a graph that compares each quarter to the same quarter of the previous year. He gets some of the figures wrong, but that is probably just routine incompetence. His reason for looking at the data this way is that it has the effect of smoothing out the rises in 2013 and exaggerating the scale of the decline in 2014.

In effect, he is using the fact that sales rose in the first year of plain packaging to amplify the decline in the year after the tax rise. This subterfuge depends on his audience not knowing when plain packaging was introduced (naturally, Chapman doesn't bother to flag up the start date of either plain packaging or the tax rise in his graph) but since most of his followers are true believers and/or idiots, he can be confident of getting away with it.

After knocking the competition, Kathleen O’Meara,
the organisation's Head of Advocacy and Communications, launched into something that sounded very much like a sales pitch for pharmaceutical nicotine products, saying "there are
better, more proven ways to quit smoking than choosing devices that
still have no regulations in Ireland... There are more
effective treatments that have been proven to increase your chances of
quitting up to four times."

She was referring to nicotine patches, sprays and gums of the kind sold by Pfizer, Novartis, GlaxoSmithKline and Roche, all of whom happen to be big money sponsors of the Irish Cancer Society.

Selling 'nicotine replacement therapy' to smokers is a lucrative business for the pharmaceutical industry but it is nickel and dime stuff compared to selling it in bulk to governments. That's why Glaxo's Director of Global Commercial Strategy told the World Health Organisation in the early days of their funding of tobacco control projects: "We could use help in the area of reimbursement."

Reimbursement means getting the government to buy whole shipments of stop-smoking drugs and dishing them out to the public at the taxpayers' expense, as he explained:

Zyban was first launched in the US, but as yet there is minimal reimbursement for Zyban in the US. In the US, 42% of people on Medicaid smoke. Federally, Medicaid does not require reimbursement for smoking cessation because it is a lifestyle decision, in the same category as hair replacement. Twenty-eight states reimburse for smoking cessation but 22 states do not, despite lawsuits, which have provided $200 billion, because smokers cannot quit on their won and long-term smoking is detrimental for health. The IRS does not allow medical expense deductions for smoking cessation because it is not a disease. The IRS is considering reversing the decision, yet there has been minimal effort to encourage the reversal. Reimbursement will increase quit attempts, make physicians more proactive.

That brings us back to the Glaxo's business partners at the Irish Cancer Society, who have been handing out free nicotine products and are campaigning for the Irish government to do likewise:

The society, in partnership with several other organisations
including National Women's Council of Ireland and the HSE, ran a 12 week
group support programme in two parts of Dublin which also saw free
nicotine replacement therapies given out.

46% of those who took part in the programme gave up smoking. [Yeah, right - CJS]

In a statement, the Irish Cancer Society explains that, "‘We Can
Quit’ provides smokers with group and one-to-one support from trained
community facilitators as well as access to free nicotine replacement
therapies (NRT), through the local pharmacy."

"We want the minister to see it, obviously. We want him to say to the HSE 'take it on'. It's not an expensive programme but unless we do something like this the smoking rate will stay high in these communities... We believe it's urgent. We believe it's important."

So she wants e-cigarettes to be heavily regulated, but wants nicotine drugs to be paid for by the taxpayer. She wants exactly what Big Pharma wants, in fact. I suspect that if the boot was on the other foot, she'd say there was a massive conflict of interest here, don't you?

Tuesday, 2 June 2015

Everyone's least favourite prohibitionist pressure group are back after a scarcely earned break with another wave of ideas about how to harass smokers. I've written about some of them for The Spectator...

Every few years, Action on Smoking and Health draws up a
wish list of all the policies it would introduce if it was king for the
day. It then spends the next few years lobbying ferociously and watches
with a satisfied smirk as every single one of their brainwaves becomes
the law of the land.

ADVERTISING

The manifesto of this tiny pressure group is, in effect, the
manifesto of whichever party is in power. The only difference is that
governments often ignore their own manifesto commitments (such as
Labour’s 2005 pledge to exempt private members clubs from the smoking
ban) whereas the ASH manifesto is always implemented to the letter.

This is a guest post by Chris Oakley about the latest smoking ban miracle.

When I read Chris’s post on the latest smoking ban miracle and the journal article it related to, something rang a bell. The laughable methodology and unjustifiably precise claims were all too familiar but so too was the name of the second author, Christopher Millet. I have written about this man once before in a post for Liberal Vision. Back in 2013. Millet, an anti-tobacco activist who believes that films containing smoking scenes should be 18 rated, conspired with Stanton Glantz to produce one of the most outrageously flawed papers that I have ever had the misfortune to read. [See here for my take on it - CJS.] Their article appeared in Pediatrics possibly because, in common with other medical journals, its acceptance standards are so low as to be practically non-existent.

Sadly, Millet escaped any censure and has gone on to contribute to yet another piece of policy based chicanery in an allegedly highly respected but apparently no more scientifically rigorous journal.Once again, the trick involves cherry picking time frames, taking advantage of unexplained variations in the data, ignoring significant contra indicators, being vague about methods and results, emphasizing irrelevant or misleading “sensitivity tests” and generally avoiding good scientific practice as much as possible whilst hiding behind a camouflage of pseudo-scientific gibberish. It is slightly more sophisticated than Millet’s last effort but not much.

The emotive and somewhat implausible claim is that the English smoking ban has led to 11,000 fewer children being admitted to hospital with lung infections every year. I have accessed the annual NHS data on the incidence of acute admissions for lower respiratory tract infections (LRTI) and upper respiratory tract infections (URTI) in the age group 0-14 and used ONS population data to produce the figure below, which shows population normalised incidence of admissions for LRTI.

I note that Been, Millet et al. omitted the data from 1999-2001 on the grounds that they only had both population and admissions data from 2001. I find that puzzling as I have population data from 1971. These two unspectacular years would almost certainly impact their model so I am suspicious.

The rise in admissions since the enforcement of the smoking ban should suggest to any sane, unbiased and even slightly enquiring mind that factors other than smoking are driving up admissions and that the ban is an irrelevance. Being hopelessly biased and questionably sane, the activists ignore logic and somehow find “evidence” to support their cherished legislation. It is hard to say how because with flagrant disregard for good scientific practice, they don’t reveal their method in any detail but my educated guess is that it may have something to do with the odd pre-ban peak in 2005-06 which they do not even mention, let alone explain.

The results section of the paper doesn’t contain actual results or a clear explanation for what passes for them. However, through the statistical smokescreen we glean that the authors are claiming that they can predict what would have happened without the ban. They do present a picture that illustrates that claim.

The data to the left of the dotted line representing the ban illustrates the difficulty in such predictions. The big winter peak is consistent but the shape of each cycle varies. Some years show a rapid fall and a small second peak, others a more gradual decline into the summer months. It is hard to see how any honest and competent scientist could derive an accurate predictive model from this data without knowing what causes these variations and allowing for it, or using a lot more cycles.

The data to the right shows the author’s model superimposed on reality. The most striking thing about it is the odd shape of the model data. The consistent high shoulder (circled in orange) is absent from any of the pre-ban data. The actual data for the first two years post-ban are remarkably similar in shape to the first two years pre-ban and I see no plausible explanation for why they should morph into the author’s creation. Been et al. are effectively claiming that a cyclic incidence pattern with significant annual variation in shape should suddenly adopt a hitherto unseen and more consistent shape because of a smoking ban not being introduced (for that is the counter-factual). The concept is ludicrous.

The authors and their chums in the press then add to the overall ridiculousness by going on to talk about falls in admissions when they actually mean unexplained rises that are, in their opinion smaller than they should have been according to an unexplained model made up by activists for smoking bans. Inexplicably, this approach survived peer review, editorial review and the hawk eyed scrutiny of the BBC health editors who allowed yet another ludicrous and hyperbolic press release to be regurgitated uncritically with added exclusive comment from a pressure group.

About Me

Writer and researcher at the Institute of Economic Affairs. Blogging in a personal capacity.
Author of Selfishness, Greed and Capitalism (2015), The Art of Suppression (2011), The Spirit Level Delusion (2010) and Velvet Glove, Iron Fist (2009).

"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."